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Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy
- Publication Year :
- 2017
- Publisher :
- American Heart Association, 2017.
-
Abstract
- Background and Purpose— Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods— One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results— Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P =0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P =0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without ( P P =0.004). Conclusions— The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.
- Subjects :
- Carotid Artery Diseases
Male
medicine.medical_specialty
medicine.medical_treatment
Hemorrhage
030204 cardiovascular system & hematology
atherosclerotic plaque
Brain Ischemia
03 medical and health sciences
0302 clinical medicine
Risk Factors
Carotid artery disease
Internal medicine
medicine
Humans
magnetic resonance imaging
Prospective Studies
Prospective cohort study
Stroke
Endarterectomy
Aged
Advanced and Specialized Nursing
Aged, 80 and over
Endarterectomy, Carotid
endarterectomy
medicine.diagnostic_test
business.industry
Cerebral infarction
Magnetic resonance imaging
Middle Aged
medicine.disease
cerebral infarction
stroke
Plaque, Atherosclerotic
Stenosis
Risk stratification
Cardiology
carotid stenosis
Female
Neurology (clinical)
Radiology
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 00392499 and 15244628
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....a40a789c86a594d70303fe8a84f50549